Provider Demographics
NPI:1629277173
Name:CIOSEK, MICHAEL (LMT)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:CIOSEK
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 8TH ST
Mailing Address - Street 2:
Mailing Address - City:SHALIMAR
Mailing Address - State:FL
Mailing Address - Zip Code:32579-1446
Mailing Address - Country:US
Mailing Address - Phone:850-218-3608
Mailing Address - Fax:
Practice Address - Street 1:87 8TH ST
Practice Address - Street 2:
Practice Address - City:SHALIMAR
Practice Address - State:FL
Practice Address - Zip Code:32579-1446
Practice Address - Country:US
Practice Address - Phone:850-218-3608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-15
Last Update Date:2007-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA47459172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist